Provider Demographics
NPI:1699756528
Name:SNIDER, RICHARD ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:SNIDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 HART ST
Mailing Address - Street 2:PO BOX 751
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-5505
Mailing Address - Country:US
Mailing Address - Phone:812-882-1241
Mailing Address - Fax:812-882-1244
Practice Address - Street 1:1830 HART ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5505
Practice Address - Country:US
Practice Address - Phone:812-882-1241
Practice Address - Fax:812-882-1244
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100155090AMedicaid
IN000000294409OtherANTHEM PROVIDER NUMBER
IN100155090AMedicaid
IN197660AMedicare ID - Type Unspecified